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Petitioners Account 18.9 - Ohio
| Petitioners Account Form. This is a Ohio form and can be used in Adoption Probate Cuyahoga County (Court Of Common Pleas) . |
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PROBATE COURT OF CUYAHOGA COUNTY, OHIO JOHN J. DONNELLY, Presiding Judge JOHN E. CORRIGAN, Judge IN THE MATTER OF THE ADOPTION OF (Name after Adoption) CASE NO. PETITIONERS ACCOUNT [R.C. 3107.10] q PRELIMINARY ESTIMATE ACCOUNTING q FINAL ACCOUNTING (To be filed not later than date petition filed) (To be filed not later than 10 days prior to date of final hearing) This accounting specifies all disbursements of anything of value the pet itioner, a person on the petitioners behalf, and the agency or attorney made and has agreed to make in connection with the mi nors permanent surrender under division (B) of Section 5103.15 of the Revised Code, placement under Section 5103.16 of the Revised Code, and adoption under Chapter 3107 of the Revised Code. (Attach extra sheets if necessary) DISBURSEMENTS MADE ACTUAL DATE NAME AND ADDRESS OR AGREED TO BE MADE COSTS PHYSICIAN HOSPITAL/MEDICAL FACILITY ATTORNEY ACTUAL COST TO THE ATTORNEY AGENCY ACTUAL COST TO THE AGENCY MAINTENANCE AND MEDICAL CARE REQUIRED UNDER R.C. 5103.15 FOSTER CARE GUARDIAN AD LITEM COURT COSTS ALL OTHER DISBURSEMENTS TOTAL 18.9 PETITIONERS ACCOUNT 3/30 American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2 CERTIFICATION OF PETITIONERS ACCOUNT The undersigned certifies this day of , 20 , that this accounting is true and accurate. Attorney or Agency Typed or Printed Name Address City State Telephone Number (include area code) The petitioner has reviewed this accounting and attests to its accuracy this day of , 20 , Petitioner Petitioner American LegalNet, Inc. www.USCourtForms.com
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